Assessment of the clinical transfusion practice at a regional referral hospital in Uganda

The aim of this study was to determine the indications for transfusion, blood ordering practices and post-transfusion complications, and to assess the clinical transfusion practice at Mbarara Regional Referral Hospital (MRRH) in Mbarara, Uganda. There are no guidelines on the appropriate use of blood at MRRH. Therefore, there was a need to assess the local clinical transfusion practice. Patients' hospital files were studied for evidence of blood transfusions in 2008. All five wards were reviewed and details on the transfusion process were recorded. A total of 1730 patients (median age, 19 center dot 0 years; range, 1 day to 88 years; female-to-male ratio, 1 center dot 4), for whom blood was cross-matched, were studied. Of these, 1674 (96 center dot 8%) patients actually received transfusions, which were as whole blood in 58 center dot 4% of recipients. The mean number of units per recipient was 1 center dot 7 and the cross-match-to-transfusion ratio was 1 center dot 3. The three most frequent indications for transfusion were malaria (38 center dot 8%), bleeding (27 center dot 1%) and other infections (16 center dot 1%). There were no records for pre-transfusion haemoglobin, compatibility testing, transfusion start-times and vital signs in 30 center dot 2, 51 center dot 8, 21 center dot 5 and 97 center dot 6% of the recipients, respectively. Transfusion reactions were recorded for 10 (0 center dot 6%) patients. Although there was no evidence of blood wastage, inadequacies were noted in the documentation of the transfusion process. There is a need to train staff in blood transfusion and to design a 'blood transfusion form' for easy monitoring and evaluation. A hospital transfusion committee and guidelines on the appropriate use of blood should be put in place at MRRH.